Skip to main content
SpringerLink
Log in

Gamma Knife Radiosurgery for Pituitary Adenomas Invading the Cavernous Sinus: Tokyo Women’s Medical University Experience

  • Chapter
  • First Online:
Gamma Knife Neurosurgery in the Management of Intracranial Disorders II

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 128))

Abstract

Total surgical removal of a pituitary adenoma (PA) invading the cavernous sinus (CS) is challenging and carries a significant risk of postoperative complications. As an alternative treatment strategy, after incomplete resection, such tumors may undergo stereotactic radiosurgery—in particular, Gamma Knife surgery (GKS). Treatment planning based on advanced neuroimaging (e.g., thin-slice 3-dimensional postcontrast constructive interference in steady state (CISS) images) allows clear visualization of the target microanatomy, which results in highly conformal and selective radiation delivery to the lesion with preservation of adjacent functionally important neurovascular structures. In the Tokyo Women’s Medical University experience of GKS for 43 nonfunctioning and 46 hormone-secreting PA invading the CS, with a minimum follow-up period of 5 years (mean 76 months, range 60–118 months), the tumor control rate has reached 97%, and a significant volume reduction (≥50%) has been seen in 24% of lesions. In cases of hormone-secreting neoplasms, normalization (in 18 patients; 39%) or improvement (in 22 patients; 48%) of endocrinological function has been noted. Importantly, such effects have been sufficiently durable. Complications have been extremely rare and limited to transient cranial nerve palsy (in 2% of cases). Notably, no patient in our series has had a new pituitary hormone deficit after irradiation. Thus, subtotal resection followed by GKS may be considered a valuable alternative to aggressive surgery for a PA invading the CS.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ding D, Starke RM, Sheehan JP. Treatment paradigms for pituitary adenomas: defining the roles of radiosurgery and radiation therapy. J Neurooncol. 2014;117:445–57.

    Google Scholar 

  2. Fahlbusch R, Buchfelder M. Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir (Wien). 1988;92:93–9.

    Google Scholar 

  3. Kitano M, Taneda M, Shimono T, Nakao Y. Extended transsphenoidal approach for surgical management of pituitary adenomas invading the cavernous sinus. J Neurosurg. 2008;108:26–36.

    Article  PubMed  Google Scholar 

  4. Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K. Transcavernous surgery: an effective treatment for pituitary macroadenomas. Eur J Endocrinol. 1995;133:156–65.

    Article  CAS  PubMed  Google Scholar 

  5. Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 1993;33:610–8.

    CAS  PubMed  Google Scholar 

  6. Chen JC, Giannotta SL, Yu C, Petrovich Z, Levy ML, Apuzzo ML. Radiosurgical management of benign cavernous sinus tumors: dose profiles and acute complications. Neurosurgery. 2001;48:1022–32.

    CAS  PubMed  Google Scholar 

  7. Fukuoka S, Ito T, Takanashi M, Hojo A, Nakamura H. Gamma Knife radiosurgery for growth hormone-secreting pituitary adenomas invading the cavernous sinus. Stereotact Funct Neurosurg. 2001;76:213–7.

    Article  CAS  PubMed  Google Scholar 

  8. Ikeda H, Jokura H, Yoshimoto T. Gamma Knife radiosurgery for pituitary adenomas: usefulness of combined transsphenoidal and Gamma Knife radiosurgery for adenomas invading the cavernous sinus. Radiat Oncol Investig. 1998;6:26–34.

    Article  CAS  PubMed  Google Scholar 

  9. Kuo JS, Chen JC, Yu C, Zelman V, Giannotta SL, Petrovich Z, MacPherson D, Apuzzo ML. Gamma Knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery. 2004;54:1385–94.

    Article  PubMed  Google Scholar 

  10. Liu AL, Wang C, Sun S, Wang M, Liu P. Gamma Knife radiosurgery for tumors involving the cavernous sinus. Stereotact Funct Neurosurg. 2005;83:45–51.

    Article  PubMed  Google Scholar 

  11. Sheehan JP, Niranjan A, Sheehan JM, Jane JA Jr, Laws ER, Kondziolka D, Flickinger J, Landolt AM, Loeffler JS, Lunsford LD. Stereotactic radiosurgery for pituitary adenomas: an intermediate review of its safety, efficacy, and role in the neurosurgical treatment armamentarium. J Neurosurg. 2005;102:678–91.

    Article  PubMed  Google Scholar 

  12. Shin M, Kurita H, Sasaki T, Tago M, Morita A, Ueki K, Kirino T. Stereotactic radiosurgery for pituitary adenoma invading the cavernous sinus. J Neurosurg. 2000;93(Suppl 3):2–5.

    Article  PubMed  Google Scholar 

  13. Tishler RB, Loeffler JS, Lunsford LD, Duma C, Alexander E III, Kooy HM, Flickinger JC. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys. 1993;27:215–21.

    Article  CAS  PubMed  Google Scholar 

  14. Hayashi M, Chernov M, Tamura N, Nagai M, Yomo S, Ochiai T, Amano K, Izawa M, Hori T, Muragaki Y, Iseki H, Okada Y, Takakura K. Gamma Knife robotic microradiosurgery of pituitary adenomas invading the cavernous sinus: treatment concept and results in 89 cases. J Neurooncol. 2010;98:185–94.

    Google Scholar 

  15. Hayashi M, Chernov M, Tamura N, Tamura M, Horiba A, Konishi Y, Okada Y, Muragaki Y, Iseki H, Takakura K. Gamma Knife radiosurgery for benign cavernous sinus tumors: treatment concept and outcomes in 120 cases. Neurol Med Chir (Tokyo). 2012;52:714–23.

    Article  Google Scholar 

  16. Hayashi M, Chernov MF, Tamura N, Izawa M, Muragaki Y, Iseki H, Okada Y, Ivanov P, Régis J, Takakura K. Concept of robotic Gamma Knife microradiosurgery and results of its clinical application in benign skull base tumors. Acta Neurochir Suppl. 2013;116:5–15.

    Article  PubMed  Google Scholar 

  17. Patronas NJ, Liu CY. State of the art imaging of the pituitary tumors. J Neurooncol. 2014;117:395–405.

    Google Scholar 

  18. Hayashi M, Ochiai T, Nakaya K, Chernov M, Tamura N, Yomo S, Izawa M, Hori T, Takakura K, Regis J. Image-guided microradiosurgery for skull base tumors: advantages of using gadolinium-enhanced constructive interference in steady-state imaging. J Neurosurg. 2006;105(Suppl):12–7.

    Article  PubMed  Google Scholar 

  19. Hayashi M, Chernov MF, Tamura N, Yomo S, Tamura M, Horiba A, Izawa M, Muragaki Y, Iseki H, Okada Y, Ivanov P, Régis J, Takakura K. Usefulness of the advanced neuroimaging protocol based on plain and gadolinium-enhanced constructive interference in steady state images for Gamma Knife radiosurgery and planning microsurgical procedures for skull base tumors. Acta Neurochir Suppl. 2013;116:167–78.

    PubMed  Google Scholar 

  20. Xie T, Zhang XB, Yun H, Hu F, Yu Y, Gu Y. 3D-FIESTA MR images are useful in the evaluation of the endoscopic expanded endonasal approach for midline skull-base lesions. Acta Neurochir (Wien). 2011;153:12–8.

    Google Scholar 

  21. Everton KL, Rassner UA, Osborn AG, Harnsberger HR. The oculomotor cistern: anatomy and high-resolution imaging. AJNR Am J Neuroradiol. 2008;29:1344–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lang M, Silva D, Dai L, Kshettry VR, Woodard TD, Sindwani R, Recinos PF. Superiority of constructive interference insteady-state MRI sequencing over T1-weighted MRI sequencing for evaluating cavernous sinus invasion by pituitary macroadenomas. J Neurosurg. 2019;130:352–9.

    Article  Google Scholar 

  23. Yagi A, Sato N, Taketomi A, Nakajima T, Morita H, Koyama Y, Aoki J, Endo K. Normal cranial nerves in the cavernous sinuses: contrast-enhanced three-dimensional constructive interference in the steady state MR imaging. AJNR Am J Neuroradiol. 2005;26:946–50.

    PubMed  PubMed Central  Google Scholar 

  24. Yagi A, Sato N, Takahashi A, Morita H, Amanuma M, Endo K, Takeuchi K. Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions. Neuroradiology. 2010;52:1101–9.

    Article  PubMed  Google Scholar 

  25. Massager N, Maris C, Nissim O, Devriendt D, Salmon I, Levivier M. Experimental analysis of radiation dose distribution in radiosurgery: I. Dose hot spot inside target volume. Stereotact Funct Neurosurg. 2009;87:82–7.

    Article  PubMed  Google Scholar 

  26. Massager N, Maris C, Nissim O, Devriendt D, Salmon I, Levivier M. Experimental analysis of radiation dose distribution in radiosurgery: II. Dose fall-off outside the target volume. Stereotact Funct Neurosurg. 2009;87:137–42.

    Article  PubMed  Google Scholar 

  27. Leber KA, Berglöff J, Pendl G. Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery. J Neurosurg. 1998;88:43–50.

    Article  CAS  PubMed  Google Scholar 

  28. Ikeda H, Jokura H, Yoshimoto T. Transsphenoidal surgery and adjuvant Gamma Knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg. 2001;95:285–91.

    Article  CAS  PubMed  Google Scholar 

  29. Hayashi M, Izawa M, Hiyama H, Nakamura S, Atsuchi S, Sato H, Nakaya K, Sasaki K, Ochiai T, Kubo O, Hori T, Takakura K. Gamma Knife radiosurgery for pituitary adenomas. Stereotact Funct Neurosurg. 1999;72(Suppl 1):111–8.

    Article  PubMed  Google Scholar 

  30. Izawa M, Hayashi M, Nakaya K, Satoh H, Ochiai T, Hori T, Takakura K. Gamma Knife radiosurgery for pituitary adenomas. J Neurosurg. 2000;93(Suppl 3):19–22.

    Article  PubMed  Google Scholar 

  31. Cifarelli CP, Schlesinger DJ, Sheehan JP. Cranial nerve dysfunction following Gamma Knife surgery for pituitary adenomas: long-term incidence and risk factors. J Neurosurg. 2012;116:1304–10.

    Article  PubMed  Google Scholar 

  32. Feigl GC, Bonelli CM, Berghold A, Mokry M. Effects of Gamma Knife radiosurgery of pituitary adenomas on pituitary function. J Neurosurg. 2002;97(5 Suppl):415–21.

    Article  PubMed  Google Scholar 

  33. Graffeo CS, Link MJ, Stafford SL, Parney IF, Foote RL, Pollock BE. Risk of internal carotid artery stenosis or occlusion after single-fraction radiosurgery for benign parasellar tumors. J Neurosurg. 2020;133:1388–95.

    Article  CAS  Google Scholar 

  34. Patibandla MR, Xu Z, Schlesinger D, Sheehan JP. Cavernous carotid stenosis following stereotactic radiosurgery for Cushing's disease: a rare complication and review of the literature. J Clin Neurosci. 2018;47:151–4.

    Article  PubMed  Google Scholar 

  35. Pomeraniec IJ, Taylor DG, Cohen-Inbar O, Xu Z, Lee Vance M, Sheehan JP. Radiation dose to neuroanatomical structures of pituitary adenomas and the effect of Gamma Knife radiosurgery on pituitary function. J Neurosurg. 2020;132:1499–506.

    Article  Google Scholar 

  36. Sasagawa Y, Tachibana O, Iizuka H. Undifferentiated sarcoma of the cavernous sinus after Gamma Knife radiosurgery for pituitary adenoma. J Clin Neurosci. 2013;20:1152–4.

    Article  PubMed  Google Scholar 

  37. Vladyka V, Liscák R, Novotný J Jr, Marek J, Jezková J. Radiation tolerance of functioning pituitary tissue in Gamma Knife surgery for pituitary adenomas. Neurosurgery. 2003;52:309–17.

    Article  PubMed  Google Scholar 

  38. Wu YH, Lin SS, Chen HH, Chang FC, Liang ML, Wong TT, Yen SH, Chen YW. Radiotherapy-related intracranial aneurysm: case presentation of a 17-year male and a meta-analysis based on individual patient data. Childs Nerv Syst. 2016;32:1641–52.

    Article  PubMed  Google Scholar 

  39. Ahmadi J, North CM, Segall HD, Zee CS, Weiss MH. Cavernous sinus invasion by pituitary adenomas. AJR Am J Roentgenol. 1986;146:257–62.

    Article  CAS  PubMed  Google Scholar 

  40. Iuchi T, Saeki N, Osato K, Yamaura A. Proliferation, vascular endothelial growth factor expression and cavernous sinus invasion in growth hormone secreting pituitary adenomas. Acta Neurochir (Wien). 2000;142:1345–51.

    Google Scholar 

  41. Marro B, Zouaoui A, Sahel M, Crozat N, Gerber S, Sourour N, Sag K, Marsault C. MRI of pituitary adenomas in acromegaly. Neuroradiology. 1997;39:394–9.

    Article  CAS  PubMed  Google Scholar 

  42. Pan LX, Chen ZP, Liu YS, Zhao JH. Magnetic resonance imaging and biological markers in pituitary adenomas with invasion of the cavernous sinus space. J Neurooncol. 2005;74:71–6.

    Google Scholar 

  43. Pomeraniec IJ, Dallapiazza RF, Xu Z, Jane JA Jr, Sheehan JP. Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study. J Neurosurg. 2016;125:202–12.

    Article  CAS  PubMed  Google Scholar 

  44. Pomeraniec IJ, Kano H, Xu Z, Nguyen B, Siddiqui ZA, Silva D, Sharma M, Radwan H, Cohen JA, Dallapiazza RF, Iorio-Morin C, Wolf A, Jane JA, Grills IS, Mathieu D, Kondziolka D, Lee CC, Wu CC, Cifarelli CP, Chytka T, Barnett GH, Lunsford LD, Sheehan JP. Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. J Neurosurg. 2018;129:648–57.

    Article  PubMed  Google Scholar 

  45. Delgrange E, Duprez T, Maiter D. Influence of parasellar extension of macroprolactinomas defined by magnetic resonance imaging on their responsiveness to dopamine agonist therapy. Clin Endocrinol. 2006;64:456–62.

    Article  Google Scholar 

  46. Tong T, Yue W, Zhong Y, Zhenwei Y, Yong H, Xiaoyuan F. Comparison of contrast-enhanced SPACE and CISS in evaluating cavernous sinus invasion by pituitary macroadenomas on 3-T magnetic resonance. J Comput Assist Tomogr. 2015;39:222–7.

    Article  PubMed  Google Scholar 

  47. Koulouri O, Kandasamy N, Hoole AC, Gillett D, Heard S, Powlson AS, O’Donovan DG, Annamalai AK, Simpson HL, Akker SA, Aylwin SJ, Brooke A, Buch H, Levy MJ, Martin N, Morris D, Parkinson C, Tysome JR, Santarius T, Donnelly N, Buscombe J, Boros I, Smith R, Aigbirhio F, Antoun NM, Burnet NG, Cheow H, Mannion RJ, Pickard JD, Gurnell M. Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI. Eur J Endocrinol. 2016;175:485–98.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Motohiro Hayashi

  2. Saitama Gamma Knife Center, Sanai Hospital, Saitama, Japan

    Motohiro Hayashi

  3. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov

  4. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Ayako Horiba, Noriko Tamura, Kosaku Amano & Takakazu Kawamata

Authors
  1. Motohiro Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikhail F. Chernov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ayako Horiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noriko Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kosaku Amano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takakazu Kawamata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Motohiro Hayashi .

Editor information

Editors and Affiliations

  1. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov

  2. Gamma Knife Unit, Department of Neurosurgery, and Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Tokyo, Japan

    Motohiro Hayashi

  3. Department of Neurosurgery, University of Minnesota Medical School, Minnesota, MN, USA

    Clark C. Chen

  4. Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ian E. McCutcheon

Ethics declarations

 The authors have no conflict of interest concerning the reported materials or methods.

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hayashi, M., Chernov, M.F., Horiba, A., Tamura, N., Amano, K., Kawamata, T. (2021). Gamma Knife Radiosurgery for Pituitary Adenomas Invading the Cavernous Sinus: Tokyo Women’s Medical University Experience. In: Chernov, M.F., Hayashi, M., Chen, C.C., McCutcheon, I.E. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders II. Acta Neurochirurgica Supplement, vol 128. Springer, Cham. https://doi.org/10.1007/978-3-030-69217-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-69217-9_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-69216-2

  • Online ISBN: 978-3-030-69217-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation